THE AMERICAN HOLISTIC NURSES CREDENTIALING CORPORATION · holistic care (Standard 13); and...

©Not to be reprinted without permission of AHNCC Revised December 2017, March 2012

THE AMERICAN HOLISTIC NURSES CREDENTIALING CORPORATION

CORE ESSENTIALS FOR THE PRACTICE OF HOLISTIC NURSING

Core Essentials for the Practice of Basic Holistic Nursing

1 © AHNCC

Revised by M. Erickson and K. Sandor, December 2017 Prepared by H Erickson, March, 2012

OVERVIEW

A. Purpose of This Document

The document, Scope and Standards of Holistic Nursing Practice, 2013, co-published by

ANA and AHNA provides an explication of the specialty, Holistic Nursing. It provides a

detailed discussion of the scope of the Holistic Nurses’ practice, including the Core

Values, Principals, Standards, and related practices. The Core Values provides a

philosophical context and guides how we think about the Standards and our practice. The

Standards set the norms or criteria for the practice; the practices explicate or spell out the

activities and behaviors required of the expert Holistic Nurse. Practice competencies

identified through the AHNCC Role Delineation Study are presented here within this

document and are embedded within the AHNA Standards of Holistic Nursing Practice.

Holistic Nurses practice at four levels: Basic Non-Baccalaureate Nursing, Basic

Baccalaureate in Nursing, Advanced Holistic Nursing, and APRN Advanced Holistic

Nursing.

The AHNCC examinations are designed to assess essential knowledge and skills

associated with the 16 (sixteen) AHNA Scope and Standards of Holistic Nursing Practice

and related Competencies for each level of practice. Because Holistic Nurses carry out

their activities and behaviors within the context of Holistic Nursing’s philosophy, the

Competencies are embedded in the Holistic Nursing Core Values. In this document Basic

Core Competencies, and more in-depth articulation specific to some competencies, are

provided.

B. Structure of the Attached Materials

1. The Essentials for Holistic Nursing is presented in four (4) sections:

a) Section 1, presents competencies expected of all Holistic Nurses, embedded in

the Core Values of Holistic Nursing. A Blueprint for the Basic Certification

Examinations follows this listing of Essential Knowledge and Skills for the

Basic Practice of Holistic Nursing.

b) Section 2, offers the examination blueprint for the HN and HNB basic holistic

nursing examinations.

c) Section 3 provides a list of selected integrative, healing practices that may be

used by Holistic Nurses.


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d) Section 4 provides Appendix A and presents the Standards and their related

competencies for the Basic Holistic Nursing examinations.

SECTION 1. ESSENTIALS FOR BASIC PRACTICE, REGISTERED

HOLISTIC NURSES1

A. Core Value: Holistic Philosophy, Theories, and Ethics

1. Holistic Nurses practice within Holistic Nursing’s philosophy, theories, and ethical

code. Specifically, the Holistic Nurse:

a) Uses ANA and AHNA documents (standards, code of ethics, to guide practice

(#71)

i. Overview of Principles of HN as defined by AHNA Scope and

Standards for Practice

a) Lists a discussion of principles and how they provide a link

between philosophy and Standards

b) Lists Standards

•Derivation of Standards

c) Relationship of Competencies to Standards

•Derivation of Competencies

ii. Relation between AHNA and ANA

b) Uses AHNA Core Values to articulate foundations of Holistic Nursing (#72)

i. Unity of all things.

a) Energy and interconnectedness of all things;

b) Consciousness;

1 This section is organized around the Core Values of Holistic Nursing. Some of the Core Values have several components. For example, Core Value 2 Holistic Nursing Practice addresses a) competencies related to quality of care and caring (i.e. Standard 10); competencies related to the traditional activities involved in the caring process (i.e. Standards 1-6); competencies related to the holistic nurse as a collaborator in provision of holistic care (Standard 13); and competencies related to the holistic nurse as a leader in provision of holistic care. The first and last two groups of competencies are not usually included in discussions of the Caring Process. Nevertheless, they are included under this Core Value because the Caring Process involves more than just the activities of carrying out the process (i.e. Standards 1-6); it also involves how it is performed, evaluation of the quality of the care provided; collaboration with peers to ensure continuity, and consistency and to serve as a learning experience for colleagues; as an opportunity to involve the entire healthcare team to maximize care efficacy, and to provide leadership for change.


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c) Nurse as an instrument of healing

• Use of presence, intentionality, unconditional

acceptance

d) Human caring, i.e. the holistic nursing process, is defined by

AHNA as “The moral ideal of nursing in which the nurse

brings one’s whole self into a relationship with the whole

self of the person being cared for in order to protect that

person’s vulnerability, preserve her or his humanity and

dignity, and reinforce the meaning and experience of

oneness and unity” (AHNA, 2013, p.90).

ii. Holistic Nursing as a caring-healing relationship/partnership with

others.

a) The Professional Holistic Nurse as an individual, partner,

collaborator, and leader

i. Nurse as an instrument of healing

ii. Nurse Self-care (as a way of attaining, maintaining own health,

restoring energy, preparing to work as energy conduit)

iii. Nurse Self-care as a precursor for creating caring-healing

partnerships

iv. Nurse Self-reflection as a primary source of self-knowledge.

v. Client as individual, family, group, community

a) The Client as expert of own health wellness

vi.) Self-knowledge is the primary source of information needed in the

caring process) includes beliefs, cultural values, folk/health

practices, life perspectives.

vii. The Family, significant others, and other healthcare as secondary

and/or tertiary sources of information.

viii. Subjective experiences provide information regarding meaning of

life experiences

ix. Alternative Health practices as optional for Holistic Nursing

practice

x. Healing environments

xi. Theories of Unity

a) Integral Theory

b) Rogers

xii. Practice Theories

a) See AHNA (2013) for extant theories

xiii. Alternative health practices commonly used by Holistic Nurses

c) Uses self as an instrument of healing (e.g. as a conduit of healing energy). (#46).

d) Models ethics and philosophy consistent with holistic nursing’s beliefs. (#53)

e) Disseminates evaluation results according to laws and regulations. (#64)

f) Honors uniqueness and inherent worthiness of clients throughout all aspects of

the holistic nursing process. (#65)


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g) Honors the individual as the authority/expert of his/her life experiences. (#66)

i. Views client as primary source of information

ii Recognizes significant others as secondary sources of information

h) Honors and facilitates the natural development of and unfolding of the client’s human

processes, and inherent capacity for self-healing#67)

I Health and wellness as the focus of HN practice, often called the

human caring process.

a) Health as a phenomena-of-quality of life and wellbeing;

b) Wellness is defined as “Integrated, congruent functioning

aimed toward reaching one’s highest potential” (AHNA,

2012, p. 92). According to the National Wellness Institute,

wellness is i.) Positive and affirming; ii.) A conscious, self-

directed and evolving process of achieving full potential;

and, iii.) multi-dimensional and holistic, encompassing

lifestyle, mental and spiritual well-being, and the

environment.

c) Sickness and disease as factors in one’s life that affect

wellbeing

i). Uses ANA Code of Ethics with Interpretive Statement and AHNA Position

Statement on Holistic Nursing Ethics and other regulations and laws to guide

practice. (#71)

j). Uses AHNA Core Values to articulate the moral foundation of holistic nursing.

(#72)

k) Practices holistic nursing care in a manner that preserves and protects the

client’s confidentiality autonomy, dignity, rights, values, and beliefs within

legal and regulatory parameters. (#73)

l). Respects the client’s choices and health trajectory, even when it is incongruent

with conventional wisdom/standards. (#74)

m) Assists persons in self- advocacy skill development, which includes making

informed choices about their care. (#76)

n) Demonstrates knowledge of the role and referral process of the ethics

committee in the organization. (#79)

o) Advocates for the holistic wellbeing of the global community with

consideration for the economy, education, and social justice. (#80)

p) Acts on behalf of vulnerable and/or marginalized individuals or groups who

cannot seek or demand ethical treatment on their own. (#81)

q) Seeks available resources in formulating holistic, ethical decisions. (#82)

r) Reports illegal, incompetent, or impaired practices (#83)

s) Approaches clients as integrated, adaptive systems, interconnected with all

other systems. (#93)

t) Acknowledges that holistic health is a multidimensional state of well-being as

perceived by the client. (#94)


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u) Focuses on facilitating the individual’s growth, holistic health, and wellbeing.

(#97).

v) Uses Presence, Intentionality, Compassion, and Authenticity throughout the

holistic nursing process. (#98)

w) Uses holistic nursing theories to help integrate one’s knowing, doing, and

being in practice. (#99)

x) Creates innovative, quality-improvement activities to initiate changes in

holistic healthcare. (#102)

y) Promotes competency in Holistic Nursing Practice to assure quality of care

for individuals, families, and communities. (108)

z) Promotes advancement of holistic nursing as a profession locally to globally.

(#120)

aa) Participates in systematic peer review considering practice standards and

guidelines, relevant statutes, rules and regulations. (#136)

bb) Identifies and reports discriminatory professional practices. (#143)

cc) Engages in nondiscriminatory professional practices. (#144)

dd) Assigns or delegates tasks as defined by the state nurse practice acts and

according to the knowledge and skills of the designated care-giver. (#145).

B. Core Value 2: Holistic Caring Process

1. The Holistic Nurses contributes to quality nursing practice. Specifically, the

Holistic Nurse

a) Approaches clients as integrated, adaptive systems, interconnected with all

systems. (#93)

b) Acknowledges that holistic health is a multidimensional state of well-being as perceived by the client. (#94)

i. Defines health as “An individually defined state or process in which the

individual (nurse, client, family, group, or community) experiences a

sense of well-being, harmony, and unity such that subjective experiences

about health, health beliefs, and values are honored; a process of

becoming, expanding consciousness.” (AHNA, 2012, p 88)

ii. Defines wellness as “Integrated, congruent functioning aimed toward

reaching one’s highest potential” (AHNA, 2012, p. 92). Wellness is i.)

Positive and affirming; ii.) A conscious, self-directed and evolving process

of achieving full potential; and, iii.) multi-dimensional and holistic,

encompassing lifestyle, mental and spiritual well-being, and the

environment. (National Wellness Institute,

http://www.nationalwellness.org; August, 2012).

iii. Defines wellbeing as a subjective experience of wellness.

http://www.nationalwellness.org/


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c) Acknowledges health and wellbeing as desired outcomes of holistic nursing.

(#95)

i. Advocates for plans that include strategies and outcomes based on

health and wellbeing as defined by holistic nurses.

d) Acknowledges self as integral with the healing environment. (#96)

e) Focuses on facilitating client’s growth, health, wellbeing. (#97)

f) Uses presence, intentionality, compassion, and authenticity throughout the

caring process. (#98)

g) Uses holistic nursing theories to integrate ones knowing, doing, and being in

practice. (#99)

h) Provides age and developmentally appropriate holistic care from infant to elder

in a culturally and ethnically sensitive manner. (#104)

i. Has basic understanding of extant holistic nursing theories and how

to use them

i) Documents relationship among diagnoses, expected outcomes, and evidence-based, holistic care plan in a secure and retrievable manner. (#28)

j) Documents implementation of holistic care plan. (#51)

k) Documents results of the evaluation. (#62)

l) Creates innovative, quality-improvement activities to initiate changes in

holistic healthcare. (#102)

m) Provides age and developmentally appropriate holistic care from infant to elder in a culturally and ethnically sensitive manner. (#104)

n) Implements processes to remove/decrease barriers to care. (#105)

o) Promotes practice competency to assure quality care for individuals, families, and communities. (#108)

p) Obtains and maintains certification in Holistic Nursing and other areas of

expertise. (#107)

q) Promotes advancement of holistic nursing as a profession locally to globally. (#120)

r) Has the ability to define a clear vision of holistic nursing practice, associated goals with implementation and evaluation plans to measure success. (#121)

s) Demonstrates energy, passion for quality holistic nursing practice. (#122)

t) Creates environments that supports holistic nursing in risk-taking behaviors.

(#123)

2) The Holistic Nurse uses self as instrument of healing. Specifically, the Holistic

Nurse:

a) Centers self before interacting with client. (#1)

i) Understands and states the purpose of centering


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ii) Acquires knowledge and skills related to self-centering

iii) Recognizes that centering may need to be repeated

b) Elicits the client’s story (to reveal the context and complexity of the human

health experience). (#3)

i) Self -knowledge (client’s story).

ii) Family (and/or significant others) perspective as secondary source

of information)

iii) Nurses ways of knowing as pertinent information needed to

provide holistic care plan.

iv) Other sources of information including medical perspective

c) Uses Presence, Intentionality, Compassion, and Authenticity throughout

the holistic nursing process (#98).

3) The Holistic Nurse collects comprehensive data relevant to the holistic paradigm.

Specifically, the Holistic Nurse:

a) Prioritizes data collection activities based on client’s immediate needs,

condition, and/or situation. (#4)

b) Collects data within the context of the holistic paradigm in a systematic and

ongoing process. (#5)

c) Uses holistic nursing concepts and theories to guide data collection. (#6)

d) Recognizes multiple ways-of-knowing as pertinent to the holistic caring

process. (#8-14)

e) Assesses (client-factors related to client’s needs, conditions, situation):

i) Perceptions and meaning of the signs and symptoms, health, illness,

sickness, wellbeing. (#15)

ii) Understanding of the diagnostic procedures, diagnosis, a treatment plan

including integrative health practices. (#16)

iii)Use of and preferences for conventional and integrative health

strategies. (#17)

iv. Learning needs and readiness to learn. (#18)

v. Values, beliefs, and cultural practices. (#19)

vi.) Lifestyle patterns and risk behaviors. (#20)

vii) Physical, mind, body, spiritual dimensions, and their interactions

(#21)

viii) Comfort status and related sources. (#22)

ix. Coping status and related resources. (#23)

x. Cultural and environmental factors effecting client’s wellbeing. (#24)

xi) Assess significant others’ perception of the client’s situation. (#25)

xii. Assess interactions between client, significant others. (#26) xiii) Strengths, challenges, and available resources (internal and external).

(#27)


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4. The Holistic Nurse analyzes data to determine the diagnosis/issues as they relate

to client needs, concerns, condition or situation. Specifically, the Holistic Nurse:

a) Uses holistic nursing theories to interpret meaning, and identify relationships

among the data collected. (#29)

b) Synthesizes data/information to identify patterns. (#30)

c) Analyzes pattern(s) of data to derive diagnoses. (#31)

d) Validates diagnosis in partnership with client. (#32)

5. The Holistic Nurse formulates realistic outcomes that emphasize holistic health

and wellbeing. Specifically, the Holistic Nurse:

a) Partners with clients to formulate realistic outcomes that emphasize health and

wellness as defined by the client. (#33)

b) Considers own expertise when defining outcomes. (#34)

c) Facilitates client’s understanding that outcomes may evolve over time. (#35)

d) Uses holistic nursing theory to help formulate the outcomes. (#36)

6. The Holistic Nurse develops a plan with strategies and alternatives needed to

attain outcomes. Specifically, the Holistic Nurse:

a) Clarifies and validates client’s understanding of the plan. (#37)

b) Facilitates client and significant others to explore holistic strategies and related

resources needed to address each of the diagnoses and the expected outcomes.

(#38)

c) Integrates spiritually-based interventions in care plan as appropriate. (#39)

d) Partners with client and significant others (as appropriate) to set timeline for

the care plan. (#40)

e) Plans care that links assessment, diagnosis, and potential side effects. (#41)

f) Uses standardized language and/or recognized terminology to document the

holistic plan. (#42)

g) Ensures inclusion of client’s values and beliefs in decision-making, holistic care

plan, and negotiation of role-responsibilities. (#43) h) Co-creates a safe and effective care plan that incorporates appropriate integrative

health practices. (#44)

7. The Holistic Nurse implements the caring-healing plan. Specifically, the Holistic

Nurse:

a) Integrates current trends, research, and evidence-based interventions specific to

the client’s needs, problem, or situation. (#45)

b) Partners with client in the entire process and ensures

i. adherence to holistic nursing philosophy, core values, principles.


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ii. safe holistic and integrative practice effectiveness. (#48)

c) Uses self as an instrument of healing or conduit of healing energy. (#46)

d) Facilitates comfort using touch intentionally when appropriate. (#47)

e) Coordinates delivery of inter-professional activities and:

i. advocates for client’s self-knowledge as essential information. (#49)

ii. Coordinates implementation of holistic care plan across settings and

caregivers. (#50)

iii. Documents implementation of holistic care plan. (#51)

iv. Facilitates client’s in establishing/maintaining relationships with

healthcare providers that are conducive to healing and attaining health

goals. (#52)

f) Promotes health-focused strategies:

i. Models ethics and philosophy consistent with Holistic Nursing beliefs.

(#53)

ii. Facilitating clients and significant others to learn that healing is a

holistic process. (#54)

iii. Creates safe learning environment. (#55)

iv. Uses teaching-learning methods appropriate to client’s needs/situation.

(#56)

v. Seeks ongoing feedback on information provided to client and

significant others as indicated. (#57)

vi. Facilitates others to access self-knowing and inner wisdom. (#58)

vii) Facilitates others to learn about conventional and integrative practices.

(#59)

g) Partners with multiple sources (e.g. clients, advocates, etc.) to create health

documents. (#60)

8. The Holistic Nurse evaluates progress toward attainment of outcomes.


a) Partners with clients and others, as indicated, to evaluate the effectiveness of

the plan, and determine factors that contribute to differences between expected

and actual holistic outcome. (#61)

b) Documents results of the evaluation. (#62)

c) Uses ongoing evaluation to mutually revise, with persons involved: the plan, diagnosis, expected outcomes, and implementation. (#63)

d) Disseminates evaluation results according to laws and regulations. (#64)

9. The Holistic Nurse collaborates with others. Specially, the Holistic Nurse:

a) Acknowledges expertise/competency of diverse disciplines. (#126)

b) Maintains compassionate/caring relationship with peers/colleagues. (#127)

c) Collaborates with inter-professional team to optimize resources needed for

holistic care plan. (#128)


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d) Participates in professional organizations in a membership capacity at local, state, national and international levels to expand promotion of holistic health. (#129)

i. Disseminates information to colleagues, peers, interdisciplinary

members, and the community regarding cost holistic health care

methods, strategies, and cost-effectiveness.

ii. Trends in health care

•Aging population

•Healthcare reform HN3590

•Nurse Coaching

e) Shares knowledge at patient-care conferences, team meetings, etc. (#130, 131)

f) Provides peers with feedback regarding their practice and/or role performance, as it affects the wellbeing of both the peer and their clients, using constructive

language and sincere communications. (#132)

10. The Holistic Nurse provides leadership for healthcare providers. Specifically,

the Holistic Nurse:

a) Engages in consultation with multi-disciplinary healthcare teams. (#115)

b) Works to create healthy environments that support holistic healthcare. (#116)

c) Demonstrates creativity and flexibility during periods of system change (#117)

d) Utilizes trending patterns of care/outcomes as these contribute to improving

practice. (#118)

e) Serves in key roles in the work setting by participating on committees, councils,

and administrative activities. (#119) f) Promotes advancement of holistic nursing as a profession locally to globally.

(#120)

g) Has the ability to define a clear vision of holistic nursing practice, associated goals with implementation and evaluation plans to measure success. (#121)

h) Demonstrates energy, excitement, and a passion for quality holistic nursing practice. (#122)

i) Creates an environment that supports holistic nursing in risk-taking behaviors. (#123)

j) Proactively promotes innovative ideas aimed at creating a caring environment conducive to client holistic health and well-being. (#124)

k) Supports appropriate balance between work and holistic self-care in the lives of

nurses and other colleagues. (#125)

h) Utilizing and allocating resources in a safe, effective, financially responsible

manner:

i) Evaluates factors such as client resources and circumstances, the safety, cost-benefits, efficiencies, and impact on practice when choosing interventions. (#141)

ii. Assigns or delegates tasks as defined by the state nurse practice acts and

according to the knowledge and skills of the designated care-giver. (#145)


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iii) Disseminates information to healthcare providers and the community

C. Core Value 3: Holistic Communication, Therapeutic Healing Environment, and

Cultural Diversity

1. The Holistic nurse communicates effectively in all areas of practice. Specifically, the

Holistic Nurse:

a) Seeks feedback from clients regarding impact and effectiveness of holistic nursing care. (#106) b) Uses communication knowledge and skills (e.g. active listening and use of technology) to interact effectively within the client’s and colleague’s worldview. (#109)

c) Validates communication with clients and colleagues to ensure constructive,

purposeful interactions. (#110)

d) Facilitates negotiations of conventional and integrative therapies or practices for continuity of care and program planning. (#111)

e) Facilitates inter-professional processes that enhance contributions of all members of the health team. (#112)

f) . Provides information related to the use, efficacy, safety, and indications of holistic and integrative health practices within the client’s context. (#113) g) Partners with client and colleagues to enhance healthcare-consumer’s perception

of wellbeing. (#114)

2. The Holistic Nurse practices in an environmentally safe and healthy manner.


a) Acknowledges that the wellbeing of the ecosystem is a determining condition

for the wellbeing of human beings. (#146)

b) Engages in activities that nurture and enhance our integral relationship with

earth. (#147)

c) Models earth stewardship through lifestyle choices. (148)

d) Proactively working to protect the wellbeing of the ecosystem. (#149)

e) Contributes to an environment conducive to the holistic, integral education of

health care providers. (#151)

f) Promotes environments that support understanding, respect, health, healing,

caring, wellbeing, wholeness, and harmony. (#147)

3. Cultural Diversity

a) Reflects on the effect of one’s cultural and spiritual beliefs, life experiences, biases,

education, and values on his/her professional practice. (#70)

b) Provides age appropriate holistic care in a culturally and ethnically sensitive

manner. (#77)


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c) Provides age and developmentally appropriate holistic care from infant to elder in a culturally and ethnically sensitive manner. (#104)

d) Uses communication knowledge and skills (e.g. active listening and use of technology) to interact effectively within the client’s and colleague’s worldview. (#109)

e) Understands the diversity of the local and community and associated resources.

(#139)

f) Incorporates cultural practices that affect the client’s holistic healthcare plan

and related outcomes. (#140)

D. Core Value 4: Holistic Education and Research

1. The Holistic Nurse attains knowledge and competence that reflects current Holistic

Nursing. Specifically, the Holistic Nurse:)

a) Seeking and acquires knowledge and skills pertinent to the practice of Holistic

Nursing. (#84) b) Seeks experience, formal and informal, to maintain and develop clinical skills,

professional knowledge, and personal growth related to holistic nursing. (#85)

c) Uses current knowledge, including research findings to expand clinical practice,

professional performance, and role development. (#86)

d) Maintains professional records that provide evidence of competency, and life-

long learning related to holistic nursing. (#87)

2. The Holistic Nurse integrates various sources of evidence including research

findings into practice. Specifically, the Holistic Nurse:

a) Demonstrates knowledge of the role and referral process of the ethics committee

in the organization. (#79) b) Uses the best available evidence, including theories and research findings, to

guide holistic nursing practice decisions throughout the nursing process. (#88)

c) Recognizes that evidence-based practice contains three components: the best

evidence, the client’s preferences, and the nurse’s expertise. (#89)

d) Participates, actively and ethically, in holistic research activities when able. (#

90)

e) Participates in the work of the research ethics committee. (#91)

f) Supports research of others on healing, wholeness, spirituality, and/or other holistic concepts. (#92)

E. Holistic Nurse Self-Reflection and Self-Care


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The Holistic Nurse evaluates own practice using current standards, statues, rules,

and regulations. Specifically, the Holistic Nurse:

a) Engages in on-going self-reflection to identify wisdom learned and areas for self-development. (#68)

b) Values all life experiences as opportunities to find personal meaning and cultivates self-awareness, self-reflection, and growth. (#69)

c) Demonstrates a commitment to practice holistic self-care strategies to manage

stress and enhance wellbeing. (#78)

d) Engages in the practice of self-care as a prerequisite to providing holistic care.

(#103)

e) Supports appropriate balance between work and holistic self-care in the lives of nurses and other colleagues. (#125)

f) Engages in self-evaluation of own professional holistic nursing practice, considering current practice standards, laws, regulations, and rules. (#133) g) Engages in self-evaluation to identify areas of strength, opportunities for

professional development with consideration to current laws, regulations, and

rules. (#134)

h) Seeks feedback (formal and informal) from clients, and colleagues/peers in

respect to professional practice. (#135)

i) Participates in systematic peer review considering practice standards and

guidelines, relevant statutes, rules and regulations. (#136)

j) Performs action(s) necessary to achieve holistic goals identified from evaluation

processes. (#137)


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SECTION 2. EXAMINATION BLUEPRINTS FOR BASIC PRACTICE,

HN and HNB EXAMINATIONS

Table 1. Blueprint, Basic Holistic Nursing (HN) Examination. Standards and Competencies Mapped by

Core Values (Examination contains 170 items)

Basic Holistic

Nursing

Core Value 1

Core Value 2

Core Value 3

Core Value 4

Core Value 5

Standards:

Competencies

(Basic HN)

Holistic

Philosophy,

Theories, and

Ethics

20%

Holistic

Caring Process

37%

Communications,

Therapeutic

Environment, Cultural

Diversity

23%

Education

and Research

11%

Self-

Reflection

and Self-Care

9%

Questions on

Examination

34 63 39 19 15

Table 2. Blueprint, Basic Holistic Nursing Baccalaureate (HNB) Examination. Standards and

Competencies Mapped by Core Values (Examination contains 190 items)

Basic Holistic

Nursing

Core Value 1

Core Value 2

Core Value 3

Core Value 4

Core Value 5

Standards:

Competencies

(Basic HN)

Holistic

Philosophy,

Theories, and

Ethics

20%

Holistic

Caring Process

37%

Communications,

Therapeutic

Environment, Cultural

Diversity

23%

Education

and Research

11%

Self-

Reflection

and Self-Care

9%

Questions on

Examination

38 70 44 21 17


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SECTION 3. HEALING, INTEGRATIVE THERAPIES THAT MAY BE USED BY

PRACTICNG HOLISTIC NURSES

1. Nutrition

2. Exercise and Movement

3. Humor, Laugher, and Play

4. Relaxation

5. Imagery

6. Music Therapy

7. Touch

8. Aromatherapy

9. Energy Therapies

10. Meditation

11. Mindfulness

12. Cognitive-behavioral therapy

13. Stress Management

14. Expressive Art Interventions

15. Mind-body Interventions such as yoga or tai chi.

16. Reflexology

17. Practices of traditional indigenous healers.


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SECTION 4. APPENDIX A. BASIC HOLISTIC NURSING COMPETENCIES

EMBEDDED IN THE AHNA STANDARDS of HOLISTIC NURSING PRACTICE

STANDARDS CORE VALUES

1. ASSESSMENT: The holistic, registered nurse collects comprehensive

data pertinent to the healthcare consumer’s health and or the

situation. The Holistic Nurse:

1. Centers self before interacting with client. CV 2 Holistic Caring Process

2. Acknowledges own personal value/belief patterns may influence

client-nurse interactions.

CV 2 Holistic Caring Process

3. Elicits client’s story (to reveal context and complexity of the human

health experience).


4. Prioritizes data collection activities based on client’s immediate

needs, condition, and/or situation.


5. Collects data within the context of the holistic paradigm in a

systematic and ongoing process.


6. Uses holistic nursing concepts to guide data collection. CV 2 Holistic Caring Process

7. Uses holistic nursing theories to guide data collection. CV 2 Holistic Caring Process

8. Uses scientific (empirical) knowing when gathering and validating

data.


9. Uses esthetic knowing when gathering and validating data. CV 2 Holistic Caring Process

10. Uses ethical knowing when gathering and validating data. CV 2 Holistic Caring Process

11. Uses own personal knowing when gathering data. CV 2 Holistic Caring Process

12. Uses sociopolitical knowing when gathering and validating data. CV 2 Holistic Caring Process

13. Uses reflective knowing when gathering and validating data. CV 5 Self-Reflection/Self-Care

14. Uses unknowing when gathering data. CV 2 Holistic Caring Process

15. Assesses client’s perceptions and meaning of signs and symptoms,

health, illness, sickness, and wellbeing.


16. Assesses client’s understanding of the diagnostic procedures, the

diagnosis, and treatment plan including integrative health practices.


17. Assesses client’s use of and preferences for conventional and

integrative health strategies.



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18. Assesses client’s learning needs and readiness to learn. CV 2 Holistic Caring Process

19. Assesses client values, beliefs, and cultural practices. CV 2 Holistic Caring Process

20. Assesses client’s lifestyle patterns and risk behaviors. CV 2 Holistic Caring Process

21. Assesses client’s physical, mind, body, spiritual dimensions and their

interactions.


22. Assesses client’s comfort status and related resources. CV 2 Holistic Caring Process

23. Assesses client’s coping status and related resources. CV 2 Holistic Caring Process

24. Assess cultural and environmental factors effecting client’s well-

being.


25. Assesses significant others’ perceptions of the situation. CV 2 Holistic Caring Process

26. Assesses interactions between the client and significant others. CV 2 Holistic Caring Process

27. Assesses client’s strengths, challenges, and available internal and

external resources.


28. Documents relationship among diagnoses, expected outcomes, and

evidence-based, holistic care plan in a secure and retrievable manner.


2. DIAGNOSIS: The holistic, registered nurse analyzes data to

determine the diagnosis or the issues. The Holistic Nurse:

29. Uses holistic nursing theories to interpret meaning and to identify

relationships among the data collected.


30. Synthesizes data/information to identify patterns. CV 2 Holistic Caring Process

31. Analyzes pattern(s) of data collected to derive diagnoses. CV 2 Holistic Caring Process

32. Validates diagnosis in partnership with client(s). CV 2 Holistic Caring Process

3. OUTCOMES IDENTIFICATION: The holistic, registered nurse identifies

expected outcomes for a plan individualized to the healthcare

consumer or the situation. The Holistic Nurse:

33. Partners with clients to formulate realistic outcomes that

emphasize holistic health and wellbeing as defined by the client.


34. Considers own expertise when defining outcomes. CV 2 Holistic Caring Process

35. Facilitates client’s understanding that different outcomes may

evolve over time.


36. Uses holistic nursing theory to formulate outcomes. CV 2 Holistic Caring Process


18 © AHNCC


4. PLANNING: The holistic, registered nurse develops a plan that

prescribes strategies and alternatives to attain expected outcomes.

The Holistic Nurse:

37. Clarifies and validates client’s understanding of the plan. CV 2 Holistic Caring Process

38. Facilitates client and significant others to explore holistic and

integrative strategies and interventions and related resources needed

to address each of the diagnoses and the expected outcomes.


39. Integrates spiritually-based interventions in care plan as

appropriate.


40. Partners with client and significant others (as appropriate) to set a

timeline for the care plan.


41. Plans care that links assessment, diagnosis, and potential side

effects.


42. Uses standardized language and/or recognized terminology to

document the holistic plan.


43. Ensures inclusion of client’s values and beliefs in decision-making,

holistic care plan, and negotiation of role-responsibilities.


44. Co-creates a safe and effective care plan that incorporates

appropriate integrative health practices.

CV 3

Communication/Therapeutic

Environment/ Cultural

Diversity

5. IMPLEMENTATION: The holistic, registered nurse implements the

identified plan. The Holistic Nurse:

45. Integrates current trends, theory, research, and evidence-based

interventions specific to the client’s needs, problem, or situation.

CV 4 Education/Research

46. Uses self as an instrument of healing (e.g. as a conduit of healing

energy).

CV 1 Holistic

Philosophy/Theory/ Ethics

47. Facilitates comfort using touch intentionally when appropriate. CV 2 Holistic Caring Process

48. Partners with client in decision-making throughout the

implementation process to ensure safe holistic and integrative practice

effectiveness.


a) Coordination of Care: The holistic, registered nurse

coordinates care delivery. The Holistic Nurse:

49. Advocates for the client’s self-knowledge as essential information. CV 2 Holistic Caring Process

50. Coordinates implementation of holistic care plan across settings and

caregivers.



19 © AHNCC


51. Documents implementation of holistic care plan. CV 2 Holistic Caring Process

52. Facilitates client in establishing/maintaining relationships with

healthcare providers that are conducive to healing and attaining health

goals.


b) Health teaching and promotion: The holistic, registered

nurse employs strategies to promote health and a safe

environment. The Holistic Nurse:

53. Models ethics and philosophy consistent with holistic nursing’s

beliefs.

CV 1 Holistic


54. Facilitates client’s and significant others to learn that healing is a

holistic process.


55. Creates safe learning environments.

CV 3



Diversity

56. Uses teaching-learning methods appropriate to the clients’ needs

and/or situation.


57. Seeks ongoing feedback on information provided to the client and

significant others as indicated.


58. Facilitates others to access self-knowing and inner wisdom. CV 2 Holistic Caring Process

59. Facilitates others to learn about conventional and integrative

practices.


60. Partners with multiple sources (e.g. clients, advocates, etc.) to

create health documents.


6. EVALUATION OF IMPLEMENTED CARE: The holistic, registered nurse

evaluates progress toward attainment of outcomes. The Holistic

Nurse:

61. Partners with clients and others, as indicated, to evaluate the

effectiveness of the plan, and determine factors that contribute to

differences between expected and actual holistic outcome.


62. Documents results of the evaluation. CV 2 Holistic Caring Process

63. Uses ongoing evaluation to mutually revise, with persons involved:

the plan, diagnosis, expected outcomes, and implementation.


64. Disseminates evaluation results according to laws and regulations. CV 1 Holistic


7. ETHICS: The holistic, registered nurse practices ethically. The

Holistic Nurse:


20 © AHNCC


65. Honors uniqueness and inherent worthiness of clients throughout

all aspects of the holistic nursing process.

CV 1 Holistic


66. Honors the individual as the authority/expert of his/her life

experiences.

CV 1 Holistic


67. Honors and facilitates the natural development of and unfolding of

the client’s human processes, and inherent capacity for self-healing.

CV 1 Holistic


68. Engages in on-going self-reflection to identify wisdom learned and

areas for self-development.

CV 5 Self-Reflection/Self-Care

69. Values all life experiences as opportunities to find personal meaning

and cultivates self-awareness, self-reflection, and growth.


70. Reflects on the effect of one’s cultural and spiritual beliefs, life

experiences, biases, education, and values on his/her professional

practice.


71. Uses ANA Code of Ethics with Interpretive Statement and AHNA

Position Statement on Holistic Nursing Ethics and other regulations and

laws to guide practice.

CV 1 Holistic


72. Uses AHNA Core Values to articulate the moral foundation of

holistic nursing.

CV 1 Holistic


73. Practices holistic nursing care in a manner that preserves and

protects the client’s confidentiality autonomy, dignity, rights, values, and

beliefs within legal and regulatory parameters.

CV 1 Holistic


74. Respects the client’s choices and health trajectory, even when it is

incongruent with conventional wisdom/standards.

CV 1 Holistic


75. Informs the person of the risks, benefits, and outcomes of holistic

healthcare regimes.

CV 1 Holistic


76. Assists persons in self- advocacy skill development, which includes

making informed choices about their care.

CV 1 Holistic


77. Provides age appropriate holistic care in a culturally and ethnically

sensitive manner.

CV3


Environment/Cultural

Diversity

78. Demonstrates a commitment to practice holistic self-care strategies

to manage stress and enhance wellbeing.


79. Demonstrates knowledge of the role and referral process of the

ethics committee in the organization.

CV 1 Holistic


80. Advocates for the holistic wellbeing of the global community with

consideration for the economy, education, and social justice.

CV 1 Holistic



21 © AHNCC


81. Acts on behalf of vulnerable and/or marginalized individuals or

groups who cannot seek or demand ethical treatment on their own.

CV 1 Holistic


82. Seeks available resources in formulating holistic, ethical decisions. CV 1 Holistic


83. Reports illegal, incompetent, or impaired practices. CV 1 Holistic


8. EDUCATION: The holistic, registered nurse attains knowledge and

competence that reflects current nursing practice. The Holistic Nurse:

84. Seeks and acquires knowledge and skills pertinent to the practice of

Holistic Nursing.


85. Seeks experience, formal and informal, to maintain and develop

clinical skills, professional knowledge, and personal growth related to

holistic nursing.


86. Uses current knowledge, including research findings to expand

clinical practice, professional performance, and role development.


87. Maintains professional records that provide evidence of

competency, and life-long learning related to holistic nursing.


9. EVIDENCE-BASED PRACTICE/RESEARCH (EBP): The holistic, registered

nurse integrates evidence and research findings into practice. The

Holistic Nurse:

88. Uses the best available evidence, including theories and research

findings, to guide holistic nursing practice decisions throughout the

nursing process.


89. Recognizes that evidence-based practice contains three components:

the best evidence, the client’s preferences, and the nurse’s expertise.


90. Participates, actively and ethically, in holistic research activities

when able.


91. Participates in the work of the research ethics committee. CV 4 Education/Research

92. Supports research of others on healing, wholeness, spirituality,

and/or other holistic concepts.


10. QUALITY OF PRACTICE: The holistic, registered nurse contributes to

quality nursing practice. The Holistic Nurse:

93. Approaches clients as integrated, adaptive systems, interconnected

with all other systems.

CV 1 Holistic


94. Acknowledges that holistic health is a multidimensional state of

well-being as perceived by the client.

CV 1 Holistic



22 © AHNCC


95. Acknowledges health and wellbeing as the desired outcome of

holistic nursing practice.

CV 1 Holistic


96. Acknowledges self as integral with the healing environment. CV 5 Self-Reflection/Self-Care

97. Focuses on facilitating the individual’s growth, holistic health, and

wellbeing.

CV 1 Holistic


98. Uses Presence, Intentionality, Compassion, and Authenticity

throughout the holistic nursing process.

CV 1 Holistic


99. Uses holistic nursing theories to help integrate one’s knowing,

doing, and being in practice.

CV 1 Holistic


100. Demonstrates quality by documenting the application of the

holistic nursing process in a responsible, accountable, and ethical

manner.

CV3



Diversity

101. Collects data to monitor quality and effectiveness of holistic

nursing practice.


102. Creates innovative, quality-improvement activities to initiate

changes in holistic healthcare.

CV 1 Holistic


103. Engages in the practice of self-care as a prerequisite to providing

holistic care.


104. Provides age and developmentally appropriate holistic care from

infant to elder in a culturally and ethnically sensitive manner.

CV3



Diversity

105. Implements processes to remove/decrease barriers to holistic

care.


106. Seeks feedback from clients regarding impact and effectiveness of

holistic nursing care.

CV3



Diversity

107. Obtains and maintains professional certification in holistic nursing

and other areas of expertise.


108. Promotes competency in Holistic Nursing Practice to assure quality

of care for individuals, families, and communities.

CV 1 Holistic


11. COMMUNICATION: The holistic, registered nurse communicates

effectively in all areas of practice. The Holistic Nurse:

109. Uses communication knowledge and skills (e.g. active listening and

use of technology) to interact effectively within the client’s and

colleague’s worldview.

CV3



Diversity


23 © AHNCC


110. Validates communication with clients and colleagues to ensure

constructive, purposeful interactions.

CV3



Diversity

111. Facilitates negotiations of conventional and integrative therapies

or practices for continuity of care and program planning.

CV3



Diversity

112. Facilitates inter-professional processes that enhance contributions

of all members of the health team.

CV3



Diversity

113. Provides information related to the use, efficacy, safety, and

indications of holistic and integrative health practices within the client’s

context.

CV3



Diversity

114. Partners with client and colleagues to enhance healthcare-

consumer’s perception of wellbeing.

CV3



Diversity

12. LEADERSHIP: The holistic, registered nurse demonstrates leadership

in the professional practice setting and the profession. The Holistic

Nurse:

115. Engages in consultation with multi-disciplinary healthcare teams.

CV3



Diversity

116. Works to create and maintain healthy work environments that

supports holistic healthcare.

CV3



Diversity

117. Demonstrates creativity and flexibility during periods of system

change.

CV3



Diversity

118. Utilizes trending patterns of care/outcomes as these contribute to

improving practice.


119. Serves in key roles in the work setting by participating on

committees, councils, and administrative activities.

CV3



Diversity


24 © AHNCC


120. Promotes advancement of holistic nursing as a profession locally to

globally.

CV 1 Holistic


121. Has the ability to define a clear vision of holistic nursing practice,

associated goals with implementation and evaluation plans to measure

success.


122. Demonstrates energy, excitement, and a passion for quality

holistic nursing practice.

CV3



Diversity

123. Creates an environment that supports holistic nursing in risk-taking

behaviors.

CV3



Diversity

124. Proactively promotes innovative ideas aimed at creating a caring

environment conducive to client holistic health and well-being.

CV3



Diversity

125. Supports appropriate balance between work and holistic self-care

in the lives of nurses and other colleagues.

CV 5 Self-Reflection /Self-Care

13. COLLABORATION: The holistic, registered nurse collaborates with

healthcare consumer, family, and others in the conduct of nursing

practice. The Holistic Nurse:

126. Acknowledges and expresses expertise and competency of diverse

disciplines.

CV3



Diversity

127. Maintains compassionate and caring relationships with peers and

colleagues.

CV3



Diversity

128. Collaborates with inter-professional team to optimize resources

needed for holistic care plan.

CV3



Diversity

129. Participates in professional organizations in a membership capacity

at local, state, national and international levels to expand promotion of

holistic health.

CV3



Diversity

130. Shares holistic nursing knowledge and skills with peers and

colleagues at patient-care conferences.



25 © AHNCC


131. Shares holistic nursing knowledge and skills with peers and

colleagues at inter-professional team meetings, conferences, and other

opportunities.


132. Provides peers with feedback regarding their practice and/or role

performance, as it affects the wellbeing of both the peer and their

clients, using constructive language and sincere communications.

CV3



Diversity

14. PROFESSIONAL PRACTICE EVALUATION: The holistic, registered

nurse evaluates her or his own nursing practice in relation to

professional practice standards and guidelines, relevant statutes,

rules, and regulations. The Holistic Nurse:

133. Engages in self-evaluation of own professional holistic nursing practice, considering current practice standards, laws, regulations, and rules.


134. Engages in self-evaluation to identify areas of strength,

opportunities for professional development with consideration to current

laws, regulations, and rules.


135. Seeks feedback (formal and informal) from clients, and

colleagues/peers in respect to professional practice.


136. Participates in systematic peer review considering practice

standards and guidelines, relevant statutes, rules and regulations.

CV 1 Holistic


137. Performs actions necessary to achieve holistic goals identified from

evaluation processes.


138. Provides rationale for holistic nursing practice beliefs, decisions,

and actions as part of evaluation processes.


15. RESOURCE UTILIZATION: The holistic, registered nurse utilizes

appropriate resources to plan and provide nursing services that are

safe, effective, and financially responsible. The Holistic Nurse:

139. Understands the diversity of the local and global community and

associated resources.

CV3



Diversity

140. Incorporates cultural practices that affect the client’s holistic

healthcare plan and related outcomes.

CV3



Diversity


26 © AHNCC


141. Evaluates factors such as client resources and circumstances, the

safety, cost-benefits, efficiencies, and impact on practice when choosing

interventions.

CV3



Diversity

142. Facilitates clients in becoming informed consumers of holistic care.

CV3



Diversity

143. Identifies and reports discriminatory professional practices. CV 1 Holistic


144. Engages in nondiscriminatory holistic nursing practices. CV 1 Holistic


145. Assigns or delegates tasks as defined by the state nurse practice acts

and according to the knowledge and skills of the designated care-giver.

CV 1 Holistic


16. ENVIRONMENTAL HEALTH: The holistic, registered nurse practices

in an environmentally safe and healthy manner. The Holistic Nurse:

146. Acknowledges that the well-being of the ecosystem of the planet is

a determining condition for the well-being of holistic human beings

CV3



Diversity

147. Engages in activities that nurture and enhance our integral

relationship with the earth.

CV3



Diversity

148. Models earth stewardship through lifestyle choices.

CV3



Diversity

149. Proactively works to protect the holistic health and well-being of

the ecosystem.

CV3



Diversity

150. Contributes to an environment that is conducive to enhancing the

holistic, integral education of healthcare providers.

CV3



Diversity

151. Promotes work environments that support understanding, respect,

health, healing, caring, wellbeing, wholeness, and harmony.

CV3



Diversity

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